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  5. Peter J. Bellafiore, MD, Inc.

Peter J. Bellafiore, MD, Inc.

Company Details

Name: Peter J. Bellafiore, MD, Inc.
Jurisdiction: Rhode Island
Entity type: Domestic Profit Corporation
Status: Activ
Date of Organization in Rhode Island: 19 Dec 1999 (25 years ago)
Identification Number: 000110031
ZIP code: 02882
County: Washington County
Principal Address: 360 KINGSTOWN RD UNIT 102, NARRAGANSETT, RI, 02882, USA
Purpose: TO PROVIDE NEUROLOGICAL HEALTH CARE TO PATIENTS.
NAICS: 621111 - Offices of Physicians (except Mental Health Specialists)

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1982758207 2007-01-23 2020-08-22 70 KENYON AVE, SUITE 321, WAKEFIELD, RI, 028794239, US 70 KENYON AVE, SUITE 321, WAKEFIELD, RI, 028794239, US

Contacts
Phone +1 401-789-4885
Fax 4017920201

Authorized person
Name PETER J BELLAFIORE
Role OWNER
Phone 4017894885

Taxonomy
Taxonomy Code 2084N0400X - Neurology Physician
License Number MD8924
State RI
Is Primary Yes

Other Provider Identifiers
Issuer BCBS OF RI
Number 20877
State RI

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PETER J. BELLAFIORE, M.D., INC. 401(K) SAFE HARBOR RETIREMENT PLAN 2015 050507754 2016-04-20 PETER J. BELLAFIORE, MD, INC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 4017894885
Plan sponsor’s address 360 KINGSTOWN ROAD, SUITE 102, NARRAGANSETT, RI, 02882

Signature of
Role Plan administrator
Date 2016-04-20
Name of individual signing PETER J. BELLAFIORE, MD
Valid signature Filed with authorized/valid electronic signature
PETER J. BELLAFIORE, M.D., INC. 401(K) SAFE HARBOR RETIREMENT PLAN 2014 050507754 2015-04-24 PETER J. BELLAFIORE, MD, INC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 4017894885
Plan sponsor’s address 360 KINGSTOWN ROAD, SUITE 102, NARRAGANSETT, RI, 02882

Signature of
Role Plan administrator
Date 2015-04-24
Name of individual signing PETER J. BELLAFIORE, MD
Valid signature Filed with authorized/valid electronic signature
PETER J. BELLAFIORE, M.D., INC. 401(K) SAFE HARBOR RETIREMENT PLAN 2013 050507754 2014-09-15 PETER J. BELLAFIORE, MD, INC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 4017894885
Plan sponsor’s address 360 KINGSTOWN ROAD, SUITE 102, NARRAGANSETT, RI, 02882

Plan administrator’s name and address
Administrator’s EIN 050507754
Plan administrator’s name PETER J. BELLAFIORE, MD, INC
Plan administrator’s address 360 KINGSTOWN ROAD, SUITE 102, NARRAGANSETT, RI, 02882
Administrator’s telephone number 4017894885

Signature of
Role Plan administrator
Date 2014-09-15
Name of individual signing PETER J. BELLAFIORE, MD
Valid signature Filed with authorized/valid electronic signature
PETER J. BELLAFIORE, M.D., INC. 401(K) SAFE HARBOR RETIREMENT PLAN 2012 050507754 2013-08-23 PETER J. BELLAFIORE, MD, INC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 4017894885
Plan sponsor’s address 360 KINGSTOWN ROAD, SUITE 102, NARRAGANSETT, RI, 02882

Plan administrator’s name and address
Administrator’s EIN 050507754
Plan administrator’s name PETER J. BELLAFIORE, MD, INC
Plan administrator’s address 360 KINGSTOWN ROAD, SUITE 102, NARRAGANSETT, RI, 02882
Administrator’s telephone number 4017894885

Signature of
Role Plan administrator
Date 2013-08-23
Name of individual signing PETER J. BELLAFIORE, MD
Valid signature Filed with authorized/valid electronic signature
PETER J. BELLAFIORE, M.D., INC. 401(K) SAFE HARBOR RETIREMENT PLAN 2011 050507754 2012-09-11 PETER J. BELLAFIORE, MD, INC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 4017894885
Plan sponsor’s address 360 KINGSTOWN ROAD, SUITE 102, NARRAGANSETT, RI, 02882

Plan administrator’s name and address
Administrator’s EIN 050507754
Plan administrator’s name PETER J. BELLAFIORE, MD, INC
Plan administrator’s address 360 KINGSTOWN ROAD, SUITE 102, NARRAGANSETT, RI, 02882
Administrator’s telephone number 4017894885

Signature of
Role Plan administrator
Date 2012-09-11
Name of individual signing PETER J. BELLAFIORE, MD
Valid signature Filed with authorized/valid electronic signature
PETER J. BELLAFIORE, M.D., INC. 401(K) SAFE HARBOR RETIREMENT PLAN 2010 050507754 2011-10-12 PETER J. BELLAFIORE, MD, INC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 4017894885
Plan sponsor’s address 360 KINGSTOWN ROAD, SUITE 102, NARRAGANSETT, RI, 02882

Plan administrator’s name and address
Administrator’s EIN 050507754
Plan administrator’s name PETER J. BELLAFIORE, MD, INC
Plan administrator’s address 360 KINGSTOWN ROAD, SUITE 102, NARRAGANSETT, RI, 02882
Administrator’s telephone number 4017894885

Signature of
Role Plan administrator
Date 2011-10-12
Name of individual signing PETER J. BELLAFIORE, MD
Valid signature Filed with authorized/valid electronic signature
PETER J. BELLAFIORE, MD, INC 401(K) RETIREMENT PLAN 2009 050507754 2010-08-11 PETER J. BELLAFIORE, MD, INC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 4017894885
Plan sponsor’s address 360 KINGSTOWN ROAD, UNIT 102, NARRAGANSETT, RI, 02882

Plan administrator’s name and address
Administrator’s EIN 050507754
Plan administrator’s name PETER J. BELLAFIORE, MD, INC
Plan administrator’s address 360 KINGSTOWN ROAD, UNIT 102, NARRAGANSETT, RI, 02882
Administrator’s telephone number 4017894885

Signature of
Role Plan administrator
Date 2010-08-11
Name of individual signing CYNTHIA R. BELLAFIORE
Valid signature Filed with authorized/valid electronic signature
PETER J. BELLAFIORE, MD, INC 401(K) RETIREMENT PLAN 2009 050507754 2010-06-30 PETER J. BELLAFIORE, MD, INC 3
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 4017894885
Plan sponsor’s address 360 KINGSTOWN ROAD, UNIT 102, NARRAGANSETT, RI, 02882

Plan administrator’s name and address
Administrator’s EIN 050507754
Plan administrator’s name PETER J. BELLAFIORE, MD, INC
Plan administrator’s address 360 KINGSTOWN ROAD, UNIT 102, NARRAGANSETT, RI, 02882
Administrator’s telephone number 4017894885

Signature of
Role Plan administrator
Date 2010-06-30
Name of individual signing CYNTHIA R. BELLAFIORE
Valid signature Filed with incorrect/unrecognized electronic signature
Role Employer/plan sponsor
Date 2010-06-30
Name of individual signing CYNTHIA R. BELLAFIORE
Valid signature Filed with incorrect/unrecognized electronic signature

Agent

Name Role Address
CYNTHIA R. BELLAFIORE Agent 360 KINGSTOWN ROAD UNIT 102, NARRAGANSETT, RI, 02882, USA

PRESIDENT

Name Role Address
PETER J. BELLAFIORE PRESIDENT 360 KINGSTOWN RD, UNIT 102 SAUNDERSTOWN, RI 02874 USA
PETER J BELLAFIORE MD PRESIDENT 71 PAMELA COURT SAUNDERSTOWN, RI 02874- USA

TREASURER

Name Role Address
CYNTHIA R BELLAFIORE TREASURER 71 PAMELA COURT SAUNDERSTOWN, RI 02874-1936 USA

SECRETARY

Name Role Address
CYNTHIA R BELLAFIORE SECRETARY 71 PAMELA COURT SAUNDERSTOWN, RI 02874-1936 USA

Filings

Number Name File Date
202446195720 Annual Report 2024-02-12
202328314450 Annual Report 2023-02-14
202209886250 Annual Report 2022-02-09
202192927260 Annual Report 2021-02-25
202034058970 Annual Report 2020-02-10
201984135300 Annual Report 2019-01-10
201856619150 Annual Report 2018-01-23
201731229900 Annual Report 2017-02-01
201691254130 Annual Report 2016-01-26
201554683110 Annual Report 2015-02-06

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 08 Oct 2024

Sources: Rhode Island Department of State

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